MEDICARE: HOLISTIC ALLIANCE NURSING PCORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner

General Provider Information

NPI Number	:	1518851567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC ALLIANCE NURSING PCORP

Provider Business Mailing Address
First Line	:	1705 CARRILLO PL UNIT 2
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91913-3245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	914 E 8TH ST STE 210
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-2565
Country	:	US
Telephone Number	:	858-402-0001
Fax Number	:	858-402-0002

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	HILARIO NOVENO JR.
Credential	:	NP
Telephone Number	:	619-874-4920

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	09/05/2025

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